Details of the latest health service workforce plans analysed

The first ever national workforce plan for the NHS was approved at the end of last year by Health Education England. Shaun Lintern analyses what it means for nursing.

As everyone in nursing knows, healthcare is labour intensive and relies on the provision of high quality services delivered by skilled professionals.

Planning for the future workforce of the NHS has been at best hit and miss in recent decades with the NHS experiencing both feast and famine in the numbers of staff available to meet the demand of patients.

Following the government’s controversial health reforms in 2012, the national body Health Education England was set-up tasked with defining the needs of the NHS in the future and the numbers and skills of the staff needed to meet that demand.

At the end of last year HEE has published its first full workforce plan for England, outlining the numbers of training places it plans to commission in 2014-15 and the trends it has identified within the existing workforce.

The plan is essentially good news for nurses. It recognises the long-term slower growth of the nursing workforce, at just 13%, against the large rise in medical consultants, at 53%, between 2002 and 2012.

Following the high profile care failings at Mid Staffordshire Foundation Trust, NHS providers appear to have realised that sufficient numbers of qualified nursing staff are vital to safe high quality patient care.

Within the Health Education England workforce plan, which is the culmination of predictions by its 13 Local Education and Training Boards as well as national workforce calculations, the impact of the Francis report into Mid Staffordshire is clear.

Employers reversed their predictions this year and have told HEE they intend to increase the acute nursing workforce by 4.7% in the year to March 2014 – an in-year growth of 3,700 full time equivalent nurses if all posts were filled.

The shortage of nurses in the NHS has already been revealed with almost a third of trusts who responded to a Nursing Times survey in the autumn admitting to seeking registered nurses from overseas in the past 12 months.

HEE has recognised this trend and, while overall employers planned to increase the number of adult nurse training places at universities in 2014-15 by 594, HEE felt this did not go far enough.

In particular, it was concerned that providers had failed to accurately predict the demand for nurses from the community sector.

Government policy is driving towards greater integration of services and a need to reduce pressure on acute services through better community care.

And yet providers predicted an overall reduction in the community workforce by 1.5% in 2013-14 and by 2.1% in 2014-15, with flat growth up to 2018.

This estimate did not include the rapid expansion of the health visitor workforce, which is due to hit 4,300 by March 2015 and will increase the total community workforce by 2%.

HEE rejected the community projections in its plan. It stated: “We believe that the current forecast demand for nurses does not appear to sufficiently reflect the move towards more integrated care with more services provided in a community setting or the need to provide services that are more responsive to the needs of vulnerable older people and those with mental health needs.

“It is therefore our collective judgment that we should not take these projections of future demand at face value. Our assessment is that because of this dissonance with national policy we will assume a higher degree of demand is likely.”

HEE stipulated there should be an extra 500 training places for adult nurses on top of the 594 proposed by employers. Its plans equate to an overall 9% rise in adult nurses. Health visitor training places have been slashed by 63% but this is because the government’s target of 4,200 are set to be reached and numbers are only needed to maintain the workforce.

In total, across pre-registration nursing and midwifery training places, numbers have increased by more than 6%, an increase of 1,882 students.

There will be a 1.4% rise in the numbers of children’s nurses, a 4% rise in learning disabilities nurses and a 1.5% rise in mental health nurses.

HEE also moderated plans for midwives after past predictions fell short. Numbers rose by 10%, roughly 500 a year between 2008 and 2013, with actual 2012-13 growth of 2.2% compared to an employer forecast of 1.3%.

The local education and training boards recommended a 0.5% reduction in midwife training places in 2014-15, a drop of 14 places overall. However, HEE overruled them, leaving the number unchanged due to a “tendency for under forecasting” and the increased use of evidence-based staffing tools, which may increase the midwife to patient ratios in future years.

Post-registration nurse training saw a rise in the numbers of practice nurses, again recognising the demand within primary care amid an ageing population with increased comorbidities. It equates to an extra 169 practice nurses. District nurse training also jumped 7.2% and school nursing increased by a more modest 3.1%.

HEE accepts data gaps could impact on its projections. These include the level of unfilled vacancies at providers, how staff working across employer boundaries are coded within the national staff record and the data quality on workforce levels within primary care and the independent and voluntary sectors.

HEE director of strategy and planning Jo Lenaghan told the HEE’s board that the increases in nurse training places was not a “kneejerk” reaction to the Francis report by employers, but was instead a “paradigm shift in how the NHS views the workforce.”

Meanwhile, HEE chief executive Ian Cumming said the workforce plan was a significant advance on what came before it.

Ian Cumming

“In the past each strategic health authority produced their own workforce plan of what their needs were but now we can look at England as a whole with both medical and non-medical workforce considered together,” he said.

“We have been able to moderate the [local] plans as well. Only time will tell whether we are right or not,” he added.

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Readers' comments
(6)

Anonymous | 21-Jan-2014 7:01 pm

COULD YOU WHEN WRITING AN ARTICLE ND USINGABREIVIATIONS AT LEAST WRITE THE FULL NAME ONCE. WHAT AND WHO IS HEE ?

Well, they had better start looking after the nurses they've already got, or there won't be enough left to care for the patients or mentor the nursing students and newly qualified coming through. Lots of nurses my age will be retiring in a few years.

Pointing out the suspicious absence of a group doesn't mean I think that group are special or that everyone else is less than. Just suggesting an acknowledgment is missing. I hope that makes my comment clear.